Monday, June 18, 2018

The origin of critical psychiatry

The origin of the term 'critical psychiatry' was probably in an edited book Critical psychiatry: The politics of mental health by David Ingleby (1980). My own edited book Critical psychiatry: The limits of madness (2006) deliberately echoed David's use of the term, and, of course, the name was adopted by the Critical Psychiatry Network (see previous post). David also contributed a chapter to my book.

In the preface to the second impression of his book (2004), David commented that "the notion of mental illness as a brain disease has become even more widely accepted than ever before" (p. 5). The essential position of critical psychiatry can be said to be the critique of this notion. Mental illness should not be reduced to brain disease (eg. see previous post). Even Thomas Szasz contributed to critical psychiatry in this respect, as he regarded the biological basis of mental illness as a myth (eg. see another previous post).

There are, of course, implications of taking this conceptual position. How critical psychiatry's essential understanding is taken forward does lead to differences within critical psychiatry (see previous post). In his introduction to the book, David suggested that, "One premise shared by all contributors to this book is that mental illness is, in fact, a political issue" [his emphasis] (p. 8). In fact, Franco Basaglia (eg. see previous post), one of the contributors to his book, tended to be less concerned about whether mental illness had an organic aetiology. His primary motivation was to abolish the asylum as, as far as he was concerned, its main purpose was to segregate the under-privileged (see extract from my book chapter).

David made it clear that "mental illnesses ... do exist" (p. 18). He, thereby, moved critical psychiatry on from Szasz's theme of 'the myth of mental illness', in the sense that Szsasz did not believe that the concept of mental illness is valid (see previous post). David also notes how some critical psychologists and others have questioned whether mental health problems "really have much to do with medicine in the first place" (p.8). However, he also quotes Peter Sedgwick, who argued that "mental illness was, after all, a medical problem" [his emphasis] (p. 9).

David juxtaposed 'positivist psychiatry', defining positivism as "the paradigm of studying human beings as if they were things' (p. 13), with 'interpretative' approaches, by which he meant "[u]nderstanding people's 'symptoms' in terms of their social situation" (p.52). Mental illnesses are "meaningful responses to difficult situations ... [but] in many conditions a 'residue' remains refractory to commonsense understanding" (p.13). Here he turned to psychoanalysis to interpret the 'residue' in terms of unconscious meanings.

David concludes his chapter by saying that “until the political component of our disagreements is brought out into the open, we will never go beyond the phoney synthesis of psychiatric ‘eclecticism’” (p.71). His book was written at the end of the period of conflict know as 'anti-psychiatry'. He does mention (on p.7) Anthony Clare's book Psychiatry in dissent, which, as I have said previously, many have seen as the compromise outcome of the anti-psychiatry debate. Clare reinforced an eclecticism in psychiatry by avoiding any clear conceptual basis for psychiatry (eg. see my Psychiatric Bulletin letter). Manschrek & Kleinman called this kind of position in psychiatry 'semi-critical' (see previous post). In many ways, psychiatry is still in this situation (see eg. previous post). The critique of psychiatry does need to go further. Critical psychiatry, in very much the sense originally used by David Ingleby, does need to be seen as a valid solution to the anti-psychiatry debate.

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